STD Case Definitions: Reportable Diseases or Conditions in Florida (Chapter 64D-3, Florida Administrative Code) General Definitions Clinical description: The clinical description provides information on physical evidence of signs or symptoms, a reported history of symptoms or exposure, or risk factors pertinent to the organism. Laboratory criteria for diagnosis: The laboratory criteria for diagnosis explains how a diagnosis can be reached and laboratory tests that can be used. Case Classification: The case classification provides information on what is necessary to be present in a case. • Probable: A probable case is one that cannot be established through laboratory testing alone, and/or where additional or alternate criteria are allowed. • Confirmed: A confirmed case is one definitively identified through laboratory testing. Chancroid (Haemophilus ducreyi)1 Clinical description: A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The disease is caused by infection with Haemophilus ducreyi. Laboratory criteria for diagnosis • Isolation of H. ducreyi from a clinical specimen Tests: Culture of H. ducreyi, Alkaline Phosphatase Test, Nitrate Reductase Test, Oxidase Test, Porphyrin Test, β-lactamase Testing, Antimicrobial Resistance Plasmids. Case classification Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by darkfield microscopic examination of ulcer exudate or by a serologic test for syphilis performed greater than or equal to 7 days after onset of ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease caused by herpes simplex virus (HSV) or a culture negative for HSV. Confirmed: a clinically compatible case that is laboratory confirmed Chlamydia (Chlamydia trachomatis), Genital Infections1 Clinical description: Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute salpingitis, or other syndromes when sexually transmitted. Female patients may report symptoms of abnormal vaginal discharge, a burning sensation when urinating, lower abdominal pain, low back pain, nausea and/or fever, pain during intercourse, bleeding between menstrual periods, or anal irritation. Male patients may report symptoms of discharge from the penis, a burning sensation when urinating, burning or itching around the opening of the penis, or anal irritation. Note, the infection is asymptomatic in approximately 70-80% of women and 60-70% of men. Perinatal infections may result in inclusion conjunctivitis and pneumonia in newborns (see definitions below). Other syndromes caused by C. trachomatis include lymphogranuloma venereum (see definitions below) and trachoma. Laboratory Criteria for Diagnosis • Isolation of C. trachomatis by culture, or • Demonstration of C. trachomatis in a clinical specimen by detection of antigen or nucleic acid Tests: Cytology (Giemsa Test, Papanicolaou Stain, Immunofluorescence Test), Direct Detection (Enzyme Immunoassay, Direct Fluorescent Antibody, Nucleic Acid Probes), Cell Culture, Serology, Susceptibility Testing of C. trachomatis Isolates. Case Classification Confirmed: a case that is laboratory confirmed Chlamydia in children ≤ 12 years of age2 Clinical description1: Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute salpingitis, or other syndromes when sexually transmitted; however, the infection is often asymptomatic in females. Perinatal infections may result in inclusion conjunctivitis and pneumonia in newborns (see definitions below). Laboratory Criteria for Diagnosis3 Specimens to screen for Chlamydia trachomatis should be obtained for culture from the rectal area and vagina of girls and from the urethra of boys. Endocervical specimens for culture are not required for prepubertal girls; only vaginal specimens are required. If vaginal discharge is present, specimens for wet mount for Trichomonas vaginalis and wet mount or Gram stain for bacterial vaginosis may be obtained as well. If the girl being evaluated is pubertal or postmenarcheal, specimens for cultures of Chlamydia trachomatis must be obtained from the endocervix. Case Classification Confirmed: a case that is laboratory confirmed Chlamydial pneumonia Clinical description3: Infection with Chlamydia trachomatis in infants may result in an afebrile illness of insidious onset occurring between 2 and 19 weeks after birth. A repetitive staccato cough, tachypnea, and rales are characteristic but not always present. Wheezing is uncommon. Hyperinflation usually accompanies infiltrates seen on chest radiographs. Nasal stuffiness and otitis media may occur. Untreated disease can linger or recur. Laboratory Criteria for Diagnosis3 In children with pneumonia, an acute microimmunofluorescent serum titer of C trachomatis-specific immunoglobulin (Ig) M of ≥ 1:32 is diagnostic. Case Classification: Confirmed: a case that is laboratory confirmed Conjunctivitis in neonates ≤ 14 days old Clinical description: A condition that may be caused by infection with Chlamydia trachomatis, Neisseria gonorrhoeae, other bacterial microbes, herpes simplex virus, or chemical exposure to prophylaxis in a neonate less than or equal to 14 days old. Signs may include inflammation of the mucous membrane that lines the inner surface of the eyelids and is continued over the forepart of the eyeball. Laboratory Criteria for Diagnosis For differential diagnosis, it is recommended that tests be done for Chlamydia trachomatis; Neisseria gonorrhoeae; and herpes simplex virus. Case Classification: A clinically compatible or confirmed case of Chlamydia trachomatis; Neisseria gonorrhoeae; Staphylococcus species; Streptococcus pneumoniae; Haemophilus influenzae, nontypeable; Streptococcus mitis; group A and B streptococci; Neisseria cinerea; Corynebacterium species; Moraxella catarrhalis; Escherichia coli; Klebsiella pneumoniae; Pseudomonas aeruginosa; or herpes simplex virus. Conjunctivitis can also be caused by chemical reactions from silver nitrate or other topical medications. Gonorrhea (Neisseria gonorrhoeae)1 Clinical description: A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infections may be asymptomatic. Female patients may report symptoms of abnormal and/or increased vaginal discharge, a burning sensation when urinating, frequent urination, pain during intercourse, bleeding between menstrual periods, or anal irritation (itching, soreness, painful bowel movements, and/or bleeding). Male patients may report symptoms of discharge from the penis, a burning sensation when urinating, burning or itching around the opening of the penis, penile (head) swelling and soreness, pain or swelling of the testicles, or anal irritation. Laboratory criteria for diagnosis • Isolation of typical gram-negative, oxidase-positive diplococci (presumptive Neisseria gonorrhoeae) from a clinical specimen, or • Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid, or • Observation of gram-negative intracellular diplococci in a urethral smear obtained from a male Tests: Direct Detection (Gram Stain, Enzyme Immunoassay, Nucleic Acid Probes), Isolation of N. gonorrhoeae, Presumptive Identification of N. gonorrhoeae (Growth and Colonial Morphology on Selective Media, Oxidase Test, Gram Staining of Colonies, Superoxol Test). Case classification Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) a written morbidity report of gonorrhea submitted by a physician Confirmed: a case that is laboratory confirmed Gonorrhea in children ≤ 12 years of age2 Clinical description1: A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infections may be asymptomatic. Laboratory criteria for diagnosis3 Specimens to screen for N. gonorrhoeae should be obtained for culture from the rectal area and vagina of girls and from the urethra of boys. Specimens should also be obtained from the pharynx even in the absence of symptoms. Endocervical specimens for culture are not required for prepubertal girls; only vaginal specimens are required. If vaginal discharge is present, specimens for wet mount for Trichomonas vaginalis and wet mount or Gram stain for bacterial vaginosis may be obtained as well. If the girl being evaluated is pubertal or postmenarcheal, specimens for cultures of N. gonorrhoeae must be obtained from the endocervix. Case classification1 Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) a written morbidity report of gonorrhea submitted by a physician Confirmed: a case that is laboratory confirmed Granuloma Inguinale (Calymmatobacterium granulomatis)1 Clinical description: A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area caused by infection with Calymmatobacterium granulomatis. A clinically compatible case would have one or more painless or minimally painful granulomatous lesions in the anogenital area. Laboratory criteria for diagnosis • Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained smears or biopsies of granulation tissue Case classification Confirmed: a clinically compatible case that is laboratory confirmed Herpes Simplex Virus (HSV) in infants up to 60 days old with disseminated infection with involvement of liver, encephalitis and infections limited to skin,